Surgeons use mosquito nets for cheap hernia operations

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The cost of life-changing hernia operations could be cut by using mosquito net mesh instead of expensive medical products, a study has found.

Hernias occur when an organ, usually the intestine, breaks free from the cavity which contains it. The condition affects one in every 1,000 people worldwide and not only causes extreme discomfort but, in many cases, restricts movement and prevents the sufferer from working.

Surgeons from Operation Hernia — an organisation that provides low-cost surgery in developing countries — found that one mosquito net, bought for around US$15, could be cut into enough meshes for 3,000 operations.

Each operation using the technique costs just US$13 for every disability-adjusted life year averted (a common metric used by the WHO and the World Bank to judge an intervention's cost-effectiveness) — even when including the costs associated with sterilisation and surgery.

This is around three times cheaper than conventional treatment, making it ideal for low income countries in the developing world.

"To provide an operation that can be truly life-changing is great — but at this price it is fantastic," said Andrew Kingsnorth, a surgeon at the Plymouth Hospital, United Kingdom, head of Operation Hernia and an author of the study, published in the British Medical Journal (15 December).

Although mosquito net mesh has been used for several years in hernia operations, surgeons still had legitimate safety concerns over their cleanliness which needed to be answered if their use was to become more widespread, he told SciDev.Net.

"It is very important that we produce data that proves that [the technique] is safe. Combined with past studies, [the new study] does just that."

His team found that simple steam or chemical sterilisation — possible in all but the most basic rural clinics — produced mosquito net mesh that was as safe to use as expensive medical-grade products. Of the 2,000 people treated with mosquito mesh by Kingsnorth and his team, only two have suffered complications caused by the material.

But only particular nets, imported from India and untreated with insecticides, have been proven to work safely and effectively.

The potential impact of the technique in the developing world could be huge, argued Kingsnorth. He estimated that the incidence of hernias in Africa could be ten times higher than in developed nations, because they are left untreated. Providing cheap hernia procedures could drastically improve life for the patients — many of whom are unable to work.

Oluyombo Awojobi, a rural surgeon in Nigeria, told SciDev.Net that the latest study is further proof that using mosquito net mesh to mend hernias is "far superior" to conventional medical supplies. He hopes that the new research would encourage more surgeons to start using the cheap mesh.

But he added: "The biggest problem standing in the way in rural regions is training. We need more people who are capable of doing the procedure".

Operation Hernia is aiming to plug this gap. Kingsnorth has helped train surgeons to use the technique in the 18 developing country locations that the organisation regularly visits.